Visiting Vet: Exposure to lilies can be toxic for cats

As I pulled my car into the Whippoorwill farm stand to pick up my weekly vegetables, I once again promised myself that next week I would ride my bike there. Counting stems of chard, I rationalized today’s carbon footprint. My lunch break was short. It was really hot. My knee hurt. There had been many stressful veterinary emergencies recently. I selected green beans, my heart vaguely nostalgic for the pick-your-own days, my knees grateful not to be stooping in the fields. And, look. We got sunflowers today and there was also a container overflowing with dramatic pink lilies for sale. Lilies.

Just last week I had seen Beauty, a plump, somewhat sedentary indoor cat, who had been vomiting for a day. Many healthy cats throw up now and again from simple things like hairballs, or eating too fast, and since she seemed to be feeling fine otherwise, her family was not overly concerned at first. But when the vomiting became frequent and persistent, they promptly sought veterinary care. They arrived with Beauty in a carrier, and a dried blossom in a plastic bag.”We bought a bouquet at the Farmer’s Market recently,” they said. “This morning, we found this on the floor.” The withered remains of a single lily.

Lilies are extremely toxic to cats. If ingested, any part of the plant — stems, leaves, blossoms, even pollen — can cause acute kidney failure. Unless treatment is initiated within 18 hours or less of exposure, it is often fatal. It doesn’t take much, either — playfully biting at the leaves, rubbing up against the bouquet, or curiously sniffing it, and even getting pollen on fur or whiskers, then grooming it off. Even such minor exposures can lead to serious consequences.

“What kind of lily was it?” I asked, examining the bagged specimen which was desiccated and colorless. All true lilies are dangerous to cats. This includes anything in the genus Lilium, like Stargazers and Tiger lilies, and also Hemerocallis, day lilies. Lily-of-the-valley, although not a true lily, is also toxic, containing a substance similar to digitalis that can cause deadly heart problems. Calla lilies and Peace lilies are not true lilies and are relatively nontoxic. They do contain a kind of insoluble crystal that, when ingested, can cause inflammation and pain in the mouth, but this is not life-threatening.

“It was a day lily,” Beauty’s mom replied. “But I really doubt she ate any of it.” There had been only one lily in the bouquet, the vase in a relatively inaccessible location. Beauty was not particularly athletic. “I think the lily just dried up and fell on the floor,” she continued. “It doesn’t look chewed. But we did read on the Internet that lilies could be poisonous to cats.”

Exactly. And, for some perverse reason, cats seem to be exceptionally attracted to lilies. The veterinary lore is full of stories about kitties going out of their way to eat lilies — pushing open doors, climbing to hard-to-reach spots, even one very arthritic 16-year-old cat who jumped up six feet to reach a bouquet. Although outdoor cats are at risk for exposure to lilies growing in the garden, most toxic episodes seem to involve cut flowers inside the home, and the number of reported events is increasing.

If ingestion is observed, rapid intervention is key. Had her owners actually witnessed Beauty eating the lily, I would have immediately tried to induce vomiting, then administered oral activated charcoal to minimize any further absorption. Absorption of what? We don’t really know. The substance in lilies that is toxic to cats has not yet been identified. In one of those bizarre curve balls thrown by Mother Nature, day lilies are actually considered edible for people. Cows who ingest them go blind. Cats develop kidney failure.

What we do know is that in the event of lily ingestion, we can support a cat’s kidneys and try to stave off the damage by using intravenous fluid therapy, ideally given round-the-clock for two full days, while monitoring renal function. If treatment is initiated within the 18 hours after ingestion, the prognosis is good. Although cats may drool or vomit soon after eating lilies, many show no signs until their kidneys start to fail, which can occur anywhere from 24 to 72 hours after exposure, at which point the prognosis worsens dramatically.

Beauty had been vomiting for 24 hours. If this really was lily toxicity, and not some other less worrisome problem causing vomiting, we were past the ideal time for instituting successful treatment. “Let’s start medication for an upset tummy,” I suggested, “but run blood work immediately to evaluate her kidneys.”

An hour later, we had the test results, which were distressingly ambiguous. Some normal, others marginally elevated. Was this just dehydration secondary to prolonged vomiting that would improve once the gastrointestinal problem resolved? Or was this evidence of lily toxicity and impending kidney failure that could rapidly worsen and ultimately be fatal?

A phone call to a veterinary toxicologist at Animal Poison Control only confirmed our uncertainty. ” I wish I could tell you not to worry,” she said, “but you’re still in that grey zone.”

It was a tough decision to make. Because of the extremely low likelihood that Beauty had truly eaten any lily, her family opted for a compromise protocol. Anti-vomiting medication. Subcutaneous fluids on an outpatient basis (rather than intravenous and hospitalization). Going home for the night.

The next day Beauty was improving. Her blood tests had happily returned to normal. The day after that, she was one hundred percent better, and we concluded her illness had not been caused by lily ingestion.

Back at the farm stand, I addressed the woman at the counter. “Hey, did you know those are poisonous to cats? Think we could put up a sign?”

Later, loading veggies into my car, I glanced back with satisfaction: the bountiful display of pink lilies was now graced with a clear warning sign — “Toxic To Cats.”

Got kitties? Then how about a nice bouquet of daisies?